The compelling anomaly of chemical intolerance

Ann N Y Acad Sci. 2001 Mar;933:1-23. doi: 10.1111/j.1749-6632.2001.tb05810.x.


In science, anomalies expose the limitations of existing paradigms and drive the search for new ones. In the late 1800s, physicians observed that certain illnesses spread from sick, feverish individuals to those contacting them, paving the way for the germ theory of disease. The germ theory served as a crude, but elegant formulation that explained dozens of seemingly unrelated illnesses affecting literally every organ system. Today, we are witnessing another medical anomaly-a unique pattern of illness involving chemically exposed groups in more than a dozen countries, who subsequently report multisystem symptoms and new-onset chemical, food, and drug intolerances. These intolerances may be the hallmark for a new disease process or paradigm, just as fever is a hallmark for infection. The fact that diverse demographic groups, sharing little in common except some initial chemical exposure event, develop these intolerances is a compelling anomaly pointing to a possible new theory of disease, one that has been referred to as "Toxicant-Induced Loss of Tolerance" ("TILT"). TILT has the potential to explain certain cases of asthma, migraine headaches, and depression, as well as chronic fatigue, fibromyalgia, and "Gulf War syndrome". It appears to evolve in two stages: (1) initiation, characterized by a profound breakdown in prior, natural tolerance resulting from either acute or chronic exposure to chemicals (pesticides, solvents, indoor air contaminants, etc.), followed by (2) triggering of symptoms by small quantities of previously tolerated chemicals (traffic exhaust, fragrances, gasoline), foods, drugs, and food/drug combinations (alcohol, caffeine). While the underlying dynamic remains an enigma, observations indicating that affected individuals respond to structurally unrelated drugs and experience cravings and withdrawal-like symptoms, paralleling drug addiction, suggest that multiple neurotransmitter pathways may be involved.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Attitude
  • Comorbidity
  • Dose-Response Relationship, Drug
  • Dyspnea / etiology
  • Environmental Exposure
  • Environmental Pollutants / adverse effects
  • Fatigue / etiology
  • Female
  • Food / adverse effects
  • Humans
  • Male
  • Models, Biological
  • Multiple Chemical Sensitivity* / diagnosis
  • Multiple Chemical Sensitivity* / epidemiology
  • Multiple Chemical Sensitivity* / etiology
  • Multiple Chemical Sensitivity* / physiopathology
  • Multiple Chemical Sensitivity* / psychology
  • Persian Gulf Syndrome / epidemiology
  • Persian Gulf Syndrome / etiology
  • Severity of Illness Index
  • Substance Withdrawal Syndrome / physiopathology
  • Substance-Related Disorders / physiopathology
  • Surveys and Questionnaires


  • Environmental Pollutants